Daytona Beach Senior AdvisorDoes Medicare pay for assisted living?
No: Medicare pays nothing toward the rent, meals or personal care in an assisted living facility, although it keeps covering the resident's doctor visits, hospital care, Part D prescriptions and any home health or hospice delivered in the facility.
This is the most common surprise for families arriving from out of state to help a parent in Palm Coast or Port Orange. Medicare Advantage plans sometimes add small extras, but none pays for assisted living.
How long does Medicare cover a nursing home stay?
Up to 100 days of skilled nursing facility care per benefit period under Part A, after an inpatient hospital stay of at least three days; days 1 to 20 carry no daily charge, days 21 to 100 carry a daily coinsurance, and coverage lasts only while daily skilled care is needed.
Time spent 'under observation' in a hospital does not count toward the three inpatient days. Ask the hospital case manager at Halifax Health or AdventHealth whether the stay is inpatient before planning a rehab move.
Does Medicare pay for help at home?
Yes, for a homebound patient under a physician's plan who needs part-time skilled nursing or therapy: Medicare-certified home health agencies make those visits at no charge, and home health aide time is covered only alongside the skilled care.
59 licensed home health agencies list an office in the two counties: 11 in Ormond Beach, 11 in Daytona Beach, 8 in DeLand, 6 in Port Orange. The office address says little about where an agency actually sends nurses. Medicare does not cover hourly companion or homemaker help, or 24-hour care at home.
Does Medicare cover hospice?
Yes: when a physician certifies a life expectancy of six months or less, Medicare's hospice benefit covers the hospice team, drugs and equipment related to the terminal illness at home, in an ALF or in a nursing home, but not room and board.
AHCA's locator shows 2 licensed hospices with an office address in the two counties: Adventhealth Hospice (Ormond Beach), Halifax Health Hospice (Port Orange). Hospice licenses cover service areas, so programs based elsewhere also serve Volusia and Flagler homes. A patient may change hospices once per benefit period and may stop hospice and return to regular Medicare coverage.
Where can seniors get free, unbiased Medicare help?
SHINE (Serving Health Insurance Needs of Elders), Florida's State Health Insurance Assistance Program run by the Department of Elder Affairs, gives free Medicare counseling through the Elder Helpline at 1-800-963-5337.
SHINE counselors are trained volunteers who sell nothing. They help with plan comparisons during open enrollment and with billing disputes year-round.
At a glance
| Medicare pays for | Medicare does not pay for | |
|---|---|---|
| Rehab | Up to 100 skilled nursing days after a qualifying stay | Long-term custodial nursing home care |
| Home | Part-time skilled home health | Hourly aides or companions |
| End of life | Hospice services, drugs and equipment | Room and board in a facility |
Sources: Chapters 408, 429 and 651, Florida Statutes; Florida Administrative Code chapters 59A-36 and 65A-2; publications of AHCA, DCF, OIR and the Department of Elder Affairs; and the CareScout and VA tables named on the page. See our editorial standards for how figures are checked.
